deLeiva A, Christlieb A R, Melby J C, Graham C A, Day R P, Luetscher J A, Zager P G
N Engl J Med. 1976 Sep 16;295(12):639-43. doi: 10.1056/NEJM197609162951203.
To determine the cause of selective aldosterone deficiency in two patients with diabetes mellitus, studies of renin and of aldosterone-precursor metabolites were performed under conditions of sodium depletion and ACTH stimulation. Plasma renin concentration was elevated in both patients, and stimulated plasma renin activity was low in one and normal in the other. Fractionation of plasma extracts demonstrated the presence of "big renin," a relatively inactive precursor of renin. Metabolites of aldosterone precursors were increased, suggesting deficient 18-hydroxylase in one patient and dehydrogenase in the other. The results suggest that hypoaldosteronism in diabetic patients may result from combined defects in both renin and aldosterone biosynthesis.
为了确定两名糖尿病患者选择性醛固酮缺乏的病因，在钠缺失和促肾上腺皮质激素刺激的条件下，对肾素和醛固酮前体代谢产物进行了研究。两名患者的血浆肾素浓度均升高，其中一名患者刺激后的血浆肾素活性较低，另一名患者则正常。血浆提取物的分级分离显示存在“大肾素”，这是肾素的一种相对无活性的前体。醛固酮前体的代谢产物增加，提示一名患者存在18-羟化酶缺陷，另一名患者存在脱氢酶缺陷。结果表明，糖尿病患者的醛固酮减少症可能是由于肾素和醛固酮生物合成的联合缺陷所致。
